Monthly Archives: August 2014

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Posole in Broth

It’s important you use great tasting broth as the base here. I did a blend of the corn broth from cooking the posole supplemented with water (to get 5 cups), a bit of bouillon, and salt substitute to taste. Just make sure it tastes like something you’d like a bowl of before moving forward with the recipe. I always cook my hominy/posole from dried kernels. A few other notes, this makes a big pot, and leftovers are great for days. Also(!) I forgot to add the scallions to my bowl before I shot the photo – apologies!

1 lb / 2 1/2 cups dried posole / hominy
1 medium white or yellow onion
5 cups great-tasting broth (see head note)
1 serrano chile, seeded and minced
2 cups / 12 ounces cooked mung beans, optional**
1 bunch of scallions, trimmed and shredded

To serve: chopped olives, sliced avocado, sprouts or micro greens, toasted sliced almonds, and/or a drizzle of lemon oil.

To cook the posole kernels, rinse and pick over the kernels, cover with water and let soak for at least six hours, or overnight. Drain, place in a large pot with the onion, halved and peeled, and cover with a few inches of water. Bring to a boil, and cook for about an hour, or until a good percentage of the kernels blossom. Drain, reserving the broth and onion, and set aside. If you’re making this ahead of time, both the broth and the cooked posole kernels (drained) freeze well.

When you’re ready to make the posole, slice the reserved onion, and add it to a large pot along with the posole kernels, and roughly 5 cups of broth – enough to just cover the kernels. Add the chile and bring to a simmer over medium heat. Gently stir in the mung beans, and scallions.

To serve, ladle into shallow bowls and add as many toppings as you can handle. Don’t skimp, really(!) they’re what make this version of posole really come together. Avocado, almonds, and chopped olives are important – so if you’re going to choose just a few, those are my recommendation. The creamy fattiness from the avocado with the starchy posole, the punch of olive brininess, and crunch from the almonds really work nicely.

Serves 6-8.

**To cook mung beans: Rinse and pick over well. Place in a saucepan, cover with water, bring to a boil, and simmer until tender but not falling apart, roughly 25-30 minutes.

Prep time: 10 min – Cook time: 70 min

Make sure to see Dr. Ben-Zur or your physician to clear you for exercise before you begin any workout program.

Here is a Youtube link to Yoga-In a Chair. This will allow you to strengthen muscles and keep as much range of motion as possible so you can live long and healthy.


Remember, before starting any exercise program, get medical clearance from Dr. Ben-Zur or your family physician. Exercise may not be right for some individuals.

Why should we exercise? Besides exercise being good for your heart, exercise is essential for:

1. Keeping your range of motion

2. Stopping Muscle loss

We all know that exercise is an integral way to lose weight. Losing weight takes stress away from your heart and decreases its work load. But as we grow older, our body begins to lose muscle and stiffen. Exercise with strength training is the only way to retard muscle loss as we age. This will keep us ambulatory as long as possible giving us the independence we need to remain happy. In addition, doing strength training allows us to keep as flexible as possible. If you are working out with bands or light weights, go through a full rang of motion and add stretching everyday to your routine. If you are in pain, exercise in a pool to relieve stress on your joints and let the water provide you with a natural restriction of motion to strengthen your muscles. Here are some tips for a strong routine:

Get in the pool: Many gyms have group classes in the pool to allow you to not only work out, but meet other people who will encourage you to continue exercise regularly.

Mix it up: Don’t just get comfortable doing the same machine day in and day out. Your body will get used to it and you will likely get bored and your health will only get marginally declining returns. Instead, take yourself out of your comfort zone and ask a trainer or gym employee to show you the proper way to use a different machine. This will ensure that you are working all of your muscles and all of your muscle fiber types.

Don’t be intimidated: The gym can be an intimidating place. I played competitive sports throughout my life so I’ve been in a gym since I was 12 years old back in Tennessee. However, if you didn’t play sports or you played sports that didn’t require lifting weights, then you likely walk in a gym and see mass confusion. Simply talk to someone that is working there and ask them to show you a couple of exercises to work different areas of your body. After you have mastered those, ask again. Don’t worry, it’s their job to help you so ask away! Once you know all the machines, you can mix and match workouts so that you are always doing different, challenging routines that will leave you feeling accomplished.

Be creative: Who says that you can’t do five minutes on a bike, then lift some weights, then jump in the pool for some laps and then cool down stretches? Stay moving and be creative.

Take a friend: It’s hard for anyone to stay motivated. Even the most dedicated gym enthusiasts need extra motivation to stay active. If you can get a friend to go, you can stay accountable to each other and feed of of each other’s energy. Choose your friends and gym buddies wisely though.

Once you begin working out you may feel sore. That is normal. Stick with it. Your body will get in shape and the soreness will go away. Once you have been working out for two weeks or so, it will become second nature. You will just be used to making it a part of your life 🙂


Live strong and happy! From your friends at The Cardiovascular Institute of Greater Los Angeles!

What are some other causes of hypertension?

Sleep Apnea:

Sleep apnea is a disease in which an individual does not breathe adequately at night. This leads to a state of hypoxia (not enough oxygen). When the body does not ventilate adequately, carbon dioxide builds up in the body which is acidic. The body tries to balance the ph by absorbing a basic compound called bicarbonate (HCO3-). This takes place in the kidneys but in order to absorb bicarbonate, water must be accompanied with it (that’s just how it is, we didn’t invent kidneys). Remember how if we have more water in our body, it enters the blood stream and increases blood volume? More blood volume equals more blood pressure.  In addition, a hypercapnic (high levels of carbon dioxide) induce blood vessels to constrict. If the arteries have less area, then blood pressure increases. The same amount of blood has to travel through a smaller vessel (Pressure = Force/Area). Hypertension due to sleep apnea needs to be controlled with medication. Fixing sleep apnea with a CPAP does little to correct blood pressure.


Hyperaldostronism is a disease where the body secretes too much aldosterone. Aldosterone is a chemical that causes the reabsorption of sodium and water in the kidney. This increases blood volume, thus pressure.  Hyperaldostronsim causes the body to lose potassium. Therefore, specific medication that prevents further loss of potassium while ridding the body of sodium is necessary to control this problem. In some instances, surgery may be needed to correct the problem.

Cushings  Disease:

Cushing’s Disease is a disease in which the body produces too much cortisol. There is a difference between Cushing’s disease and Cushing’s syndrome. However, that is beyond the scope of this blog. For now just remember that cortisol increases blood pressure and is treated surgically.

Renal Artery Stenosis:

Renal Artery Stenosis occurs when the arteries that supply the kidneys have an area of stenosis unilaterally or bilaterally. Since all blood flows through the kidneys to be filtered, when the arteries become stenosed, the flow of blood is hindered and increases the blood pressure against the walls of the capillaries. Renal artery stenosis is usually suspected after numerous medial trials have failed.

Medication as cause:

There are a vast number of medications that can induce hypertension in an individual. Your physician will work with you on finding the right medication schedule in order to minimize hypertension and discuss strategies.


A growing number of people are taking compounds like testosterone, Human Growth Hormone, Insulin-like Growth Factor (IGF-1), and pre-workout supplements. These substances are extremely dangerous. Testosterone cause increased blood pressure and arterial tone, human growth factor can cause the heart to become more muscular and less effective at pumping blood-this is lethal, and pre-workouts contain substances that activate the sympathetic nervous system and cause arteries to constrict (which increases blood pressure). In addition, pre-workouts cause the heart to work even harder against higher pressures. Eventually, the heart will fatigue and fail prematurely.  Always be forthcoming with your physician about drugs and compounds that you are taking. Your physician has a confidentiality agreement with you and cannot disclose such activity. Your physician cares about you and just wants to be able to serve you better.


Medications that treat hypertension:

Thiazide diuretics- (water pills): Thiazide diuretics act on the kidney to excrete sodium. Remember, where sodium goes, water goes. These pills reduce water in the body thus, reduce blood volume and pressure.

Loop Diuretics- (furosemide, Lasix): Loop diuretics are powerful diuretics that block sodium, potassium, and chloride from entering the body in excess. Water is attracted to these molecules so blocking them also blocks water from entering the body and reduces blood volume and pressure.

Potassium sparing diuretics (spironolactone, triamterene): These diuretics block the aldosterone receptor and hold on to potassium. This drug is used in special cases such as hyperaldostronism and often sleep apnea.

ACE Inhibitors- (lisinopril, “prils”): These drugs block an enzyme that converts a series of compounds from causing an increase in water volume and constriction of the blood vessels. These medications are particularly useful in diabetics and have been shown to prevent diabetic damage to kidneys.

ARB’s (losartan, “sartans”): These drugs block a compound called angiotensin from binding to their receptors and causing vasoconstriction (constriction of the arteries).

Carbonic anyhydrase inhibitors: (acetazolamide): These drugs block carbonic anhydrase in the kidney and are used for mountain sickness but have a weak effect on total water loss so they are not commonly used.

Alpha 2 agonists (clonidine): Inhibits sympathetic outflow which causes vasodilation which widens the lumen of the artery thus decreasing pressure

Beta blockers (atenolol, “olol’s”): These drugs act in numerous ways which your physician can discuss. There are several varieties that work on different beta and also alpha receptors.

Calcium Channel blockers: These drugs have two subclasses and numerous effects. Please discuss these medications with your physician for more information.

Please join our blog! We want to hear from you and discuss your individual concerns and experiences. We welcome patients, students, and physicians.

Original recipe makes 4 servings
  • 15 mins
  • COOK15 mins
  • READY IN30 mins


  1. In a saucepan bring water to a boil. Add quinoa and a pinch of garlic powder. Reduce heat to low, cover and simmer for 15 minutes. Allow to cool to room temperature; fluff with a fork.
  2. Meanwhile, in a large bowl, combine olive oil, salt substitute, lemon juice, orange juice, tomatoes, cucumber, green onions, carrots and parsley. Stir in cooled quinoa.


For heart disease patients or for those with risk factors it is vital to have a healthy diet in addition to regular exercise program to live a high quality of life. In general try to design your meals consisting of the following food groups.

  • Increase your intake of healthy fats and reduce saturated fats ↑ nuts, seeds and olive or canola oil  and ↓ red meat and full-dairy products
  • Eat more fish. Fish is rich in omega-3 fatty acids, which can protect your heart and lower triglycerides, according to Walnuts and flaxseed also contain omega-3.
  • Healthy sources of lean protein include soybeans and soy products, beans and lentils. While these don’t contain omega-3, they are low in cholesterol and a good addition to a diet rich in fish and seafood.
  • Increase the amount of fruits and vegetables, the more the better. Green leafy vegetables are especially important because they are high in fiber, which can help lower cholesterol.
  • Eat more whole grains. Good choices for whole grains include whole wheat, brown rice, ground flaxseed, oatmeal and buckwheat.
  • Reduce the amount of salt in the meals and the best choice is to go salt free. Instead of mimicking the taste of sodium with salt substitutes, experiment with flavorful herbs and spices. Try fresh garlic or garlic powder, lemon juice, flavored vinegar, salt-free herb blends, cumin, nutmeg, cinnamon, fresh ground pepper, tarragon and oregano.



Try to consume fruits and veggies of all colors.


Instead of table salt (sodium chloride) incorporate various different spices and herbs for different and unique taste.


The following is a sample 1 week recipe for you.




American Heart Association main website has an excellent page dedicated to providing nutrition and diet information that will provide even more information on recipes and grocery shopping tips.



  • 7-Day Heart-Healthy Meal Plan (Healthy Recipes, Healthy Eating, Healthy Cooking)
  • Meal Plan for Heart Disease (LIVESTRONG.COM)
  • Cleveland Clinic – Salt Substitutes (Cleveland Clinic)

“You probably know about  the relationship between smoking and lung cancer, but did you know smoking is also linked to heart disease, stroke and other chronic lung diseases?  Smoking can also increase your risk for cancer of the bladder, throat and mouth, kidneys, cervix and pancreas.  Thinking about quitting? Look at the facts!

Why you should quit?

  • Smoking is the most preventable cause of death in the United States.
  • Smoking causes more than one in five deaths in America.
  • 90 percent of lung cancer in men is directly related to smoking and 80 percent of lung cancer in women is caused by cigarettes.
  • About 23 percent of adult men and about 18 percent of adult women smoke.
  • The highest percentage of people who smoke are between the ages of 25 and 44.
  • According to the American Heart Association, most adult smokers started smoking when they were preteens or teenagers. Unfortunately, many young people don’t fully understand the dangers of smoking.
  • About 60 percent of American children ages 4-11 are exposed to secondhand smoke at home.
  • On average, smokers die 13 to 14 years earlier than nonsmokers.
  • Since 1965, more than 45 percent of adults who have ever smoked have quit.
  • You can be one of the millions of people who successfully quit every year.

Dangers of Smoking GraphicWhat makes cigarettes so toxic and dangerous?

There are 4,000 chemical components found in cigarettes and at least 250 of them are harmful to human health, according to the Centers for Disease Control and Prevention.

Here are a few examples:

  • 1,3-Butadine is a chemical used to manufacture rubber.  According to the CDC, “it may increase risk of cancer in the stomach, blood and lymphatic system.”
  • Acrolein is a gas linked to lung cancer. It inhibits DNA repair and can destroy the lining in the lungs that protects you from lung disease.
  • Arsenic is used to preserve wood.  In humans, it can cause heart disease and cancer.
  • Benzene is used to manufacture other chemicals. It can cause cancer, particularly leukemia, in humans.
  • Cadmium is a metal used to make batteries.  Cadmium can interfere with the repair of damaged DNA, as well as damage the kidneys and the lining of the arteries.
  • Chromium VI is used to make alloy metals, paint and dyes.  It has been proven to be linked to lung cancer.
  • Formaldehyde is a chemical used to kill bacteria and preserve human and animal remains.  It’s a known cause of cancer, one of the main substances linked to chronic lung disease and a very toxic ingredient in secondhand smoke.
  • Polonium-210 is a radioactive element inhaled directly into the airway.  Some studies show that people who smoke a pack-and-a-half of cigarettes a day are receiving the same radiation they’d get from 300-plus X-rays per year!
  • Tar is solid, inhaled chemicals linked with an increased risk for cancer.  It also leaves a sticky, brown residue on your lungs, teeth and fingernails.

Carbon monoxide & nicotine: A dangerous duo

Carbon monoxide is a harmful gas you inhale when you smoke.  Once in your lungs, it’s transferred to your bloodstream.  Carbon monoxide decreases the amount of oxygen that is carried in the red blood cells.  It also increases the amount of cholesterol that is deposited into the inner lining of the arteries which, over time, can cause the arteries to harden.  This leads to heart disease, artery disease and possibly heart attack.
Nicotine is a dangerous and highly addictive chemical. It can cause an increase in blood pressure, heart rate, flow of blood to the heart and a narrowing of the arteries (vessels that carry blood). Nicotine may also contribute to the hardening of the arterial walls, which in turn, may lead to a heart attack. This chemical can stay in your body for six to eight hours depending on how often you smoke.  Also, as with most addictive substances, there are some side effects of withdrawal.

Second-Hand Smoke

Smokers aren’t the only ones affected by tobacco smoke. Secondhand smoke is a serious health hazard for nonsmokers, especially children. Nonsmokers who have high blood pressure or high blood cholesterol have an even greater risk of developing heart diseases when they’re exposed to secondhand smoke.

Environmental tobacco smoke causes about 46,000 heart disease deaths and 3,400 lung cancer deaths. Studies show that the risk of developing heart disease is about 25-30 percent higher among people exposed to environmental tobacco smoke at home or work. Secondhand smoke promotes illness, too. Children of smokers have many more respiratory infections than do children of nonsmokers. Nonsmoking women exposed to tobacco smoke are also more likely to have low-birthweight babies. Excerpted and adapted from “When Risk Factors Unite,” appearing in the Stroke Connection Magazine January/February 2005 (Science update May 2008)

These are just a few of the dangerous chemicals found in cigarettes; there are many more.  But you do not have to spend the rest of your life giving in to your addiction! Thousands of people kick the habit every year, and you can be one of them.  It may not be easy, but you can do it!”


Diabetes and Cardiovascular Disease

The top causes of death and disability for people with type 2 diabetes are similar to those for people without diabetes: Heart disease and stroke. Numerous studies exist linking cardiovascular disease (CVD) and diabetes. People who suffer from diabetes are 2-4 times more likely to have heart disease or a stroke than adults without diabetes. Diabetes is a major risk factor for a cardiovascular condition called atherosclerosis which can result in kidney disease and high blood pressure, platelet (a component of blood) abnormalities and abnormal vascular reactivity, which means blood vessels stop responding normally to signals from the body.

More than 65% of people with diabetes die from stroke or a cause related to heart disease.

The good news is that the American Heart Association classifies diabetes as one of seven major controllable risk factors for cardiovascular disease. This means with good control of your diabetes through diet, exercise, medical management and frequent visits to your doctor, you may be able to reduce your risks.

Other factors that contribute to the development of cardiovascular disease include high blood pressure, abnormal cholesterol and elevated triglycerides, obesity, sedentary lifestyle, smoking, and poorly controlled blood sugars.

High or uncontrolled sugar levels in the blood result in damage to body, especially the blood vessels, eyes and kidneys. Blood tests that look at glucose (sugar) and glycosylated hemoglobin (HgbA1C) help you and your healthcare provider to know how well your sugar levels are being controlled. If your glucose levels are elevated you can help to normalize them through dietary choices, exercise and by taking medications.

All of the reasons are not fully understood why diabetes leads to a higher risk of CVD. People who suffer from diabetes may have associated conditions such as high cholesterol, triglycerides or a sedentary lifestyle which are already well known risk factors. Experts have suggested diabetes may have a direct effect of CVD thorough increasing the risk of thrombus formation in the heart, making platelets more reactive (increased clotting) and by making endothelial dysfunction worse. Worsening endothelial dysfunction means that the blood vessels don’t constrict and dilate normally, and this can lead to the plaque formation and thickening associated with atherosclerosis.

For more information:

Aspirin for Primary Prevention of Cardiovascular Events in People with Diabetes. ADA/AHA/ACCF Scientific Statement. 2010.

Diabetes and the cardiologists: a call to action. 2000. J Am Coll Cardiol.

Cardiac stress test (or Cardiac diagnostic test) is a test used in medicine and cardiology to measure the heart’s ability to respond to external stress in a controlled clinical environment.

The stress response is induced by exercise or drug stimulation. Cardiac stress tests compare the coronary (heart) circulation while the patient is at rest with the same patient’s circulation observed during maximum physical exertion, showing any abnormal blood flow to the heart’s muscle tissue (the myocardium). This test can be used to diagnose ischemic heart disease, and for patient prognosis after a heart attack (myocardial infarction).

The cardiac stress test is done with heart stimulation, either by exercise on a treadmill, pedaling a stationary exercise bicycle ergometer or with intravenous pharmacological stimulation, with the patient connected to an electrocardiogram (or ECG). People who cannot use their legs may exercise with a bicycle-like crank that they turn with their arms.

The level of mechanical stress is progressively increased by adjusting the difficulty (steepness of the slope) and speed. The test administrator or attending physician examines the symptoms and blood pressure response. With use of ECG, the test is most commonly called a cardiac stress test, but is known by other names, such as exercise testing, stress testing treadmills, exercise tolerance test, stress test or stress test ECG.

Nuclear stress test

The best known example is myocardial perfusion imaging. Typically, a radiotracer (Tc-99 sestamibi, Myoview or Thallous Chloride 201) may be injected during the test. After a suitable waiting period to ensure proper distribution of the radiotracer, scans are acquired with a gamma camera to capture images of the blood flow. Scans acquired before and after exercise are examined to assess the state of the coronary arteries of the patient.

Showing the relative amounts of radioisotope within the heart muscle, the nuclear stress tests more accurately identify regional areas of reduced blood flow.

Stress and potential cardiac damage from exercise during the test is a problem in patients with ECG abnormalities at rest or in patients with severe motor disability. Pharmacological stimulation from vasodilators such as dipyridamole or adenosine, or positive chronotropic agents such as dobutamine can be used. Testing personnel can include a cardiac radiologist, a nuclear medicine physician, a nuclear medicine technologist, a cardiology technologist, a cardiologist, and/or a nurse.

The American Heart Association recommends ECG treadmill testing as the first choice for patients with medium risk of coronary heart disease according to risk factors of smoking, family history of coronary artery stenosis, hypertension, diabetes and high cholesterol.

Perfusion stress test (with 99mTc labelled sestamibi) is appropriate for select patients, especially those with an abnormal resting electrocardiogram.

Intracoronary ultrasound or angiogram can provide more information at the risk of complications associated with cardiac catheterization.

Diagnostic value

The common approach for stress testing by American College of Cardiology and American Heart Association indicates the following:

Treadmill test: sensitivity 73-90%, specificity 50-74% (Modified Bruce Protocol)

Nuclear test: sensitivity 81%, specificity 85-95%

(Sensitivity is the percentage of sick people who are correctly identified as having the condition. Specificity indicates the percentage of healthy people who are correctly identified as not having the condition.)

The value of stress tests has always been recognized as limited in assessing heart disease such as atherosclerosis, a condition which mainly produces wall thickening and enlargement of the arteries. This is because the stress test compares the patient’s coronary flow status before and after exercise and is suitable to detecting specific areas of ischemia and lumen narrowing, not a generalized arterial thickening.

According to American Heart Association data,[citation needed] about 65% of men and 47% of women have as their first symptom of cardiovascular disease a heart attack or sudden cardiac arrest. Stress tests, carried out shortly before these events, are not relevant to the prediction of infarction in the majority of individuals tested. Over the past two decades, better methods[citation needed] have been developed to identify atherosclerotic disease before it becomes symptomatic.

These detection methods have included either anatomical or physiological.

Examples of anatomical methods include:

  • CT coronary calcium score
  • Intima-media thickness (IMT)
  • Intravascular ultrasound (IVUS)
  • Examples of physiological methods include
  • Lipoprotein analysis
  • HbA1c
  • Hs-CRP
  • Homocysteine

The anatomic methods directly measure some aspects of the actual process of atherosclerosis itself and therefore offer the possibility of early diagnosis, but are often more expensive and may be invasive (in the case of IVUS, for example). The physiological methods are often less expensive and more secure, but are not able to quantify the current status of the disease or directly track progression.

Pharmacological agents

The choice of pharmacologic stress agents used in the test depends on factors such as potential drug interactions with other treatments and concomitant diseases.

Pharmacologic agents such as Adenosine, Lexiscan (Regadenoson), or dipyridamole is generally used when a patient cannot achieve adequate work level with treadmill exercise, or has poorly controlled hypertension or left bundle branch block. However, an exercise stress test may provide more information about exercise tolerance than a pharmacologic stress test.

Commonly used agents include:

Vasodilators acting as adenosine receptor agonists, such as Adenosine itself, and Dipyridamole (brand name “Persantine”), which acts indirectly at the receptor.

Regadenoson (brand name “Lexiscan”), which acts specifically at the Adenosine A2A receptor, thus affecting the heart more than the lung.

Dobutamine. The effects of beta-agonists such as dobutamine can be reversed by administering beta-blockers such as propranolol.

Lexiscan (Regadenoson) or Dobutamine is often used in patients with severe reactive airway disease (Asthma or COPD) as adenosine and dipyridamole can cause acute exacerbation of these conditions. If the patient’s Asthma is treated with an inhaler then it should be used as a pre-treatment prior to the injection of the pharmacologic stress agent. In addition, if the patient is actively wheezing then the physician should determine the benefits versus the risk to the patient of performing a stress test especially outside of a hospital setting. Caffeine is usually held 24 hours prior to an adenosine stress test, as it is a competitive antagonist of the A2A adenosine receptor and can attenuate the vasodilatory effects of adenosine.

Aminophylline may be used to attenuate severe and/or persistent adverse reactions to Adenosine and Lexiscan.



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